Using the Nurse Coaching Process to Support Bereaved Staff During the COVID-19 Crisis

Abstract

Nurses are confronting a number of negative mental health consequences owing to high burdens of grief during COVID-19. Despite increased vaccination efforts and lower hospitalization and mortality rates, the long-term effects of mass bereavement are certain to impact nurses for years to come. The nurse coaching process is an evidence-based strategy that nurse leaders can use to assist staff in mitigating negative mental health outcomes associated with bereavement. The End-of-Life Nursing Education Consortium brought together a team of palliative nursing experts early in the pandemic to create resources to support nurses across settings and promote nurse well-being. This article shares a timely resource for health systems and nursing administration that leverages the nurse coaching process to support bereaved staff in a safe and therapeutic environment.

Nurses are being pushed beyond their limits during the COVID-19 response. Health systems and the nurses they employ continue to be faced with understaffing, long hours, ethical dilemmas, substantial numbers of patient deaths, and the emotional demands of supporting families remotely through grief and bereavement.¹ More than a year into the pandemic, these stressors are compounding over time, with little opportunity for nurses to process their own grief—contributing to a mounting psychological toll.

Nurses responding to COVID-19 have reported a variety of mental health symptomatology: up to 64% have reported psychological distress^2,3; 53%, depression^3,4; and 41%, anxiety.^3,4 Risk factors, such as witnessing patient deaths, have been associated with particularly deleterious effects on these mental health outcomes (eg, a 4-fold increase in the likelihood of posttraumatic stress symptoms).⁵ Furthermore, nurses screen positive for these outcomes at higher rates than other health care providers.^3,6

It is estimated that the prolonged effects of these mental health outcomes could last up to 3 years,⁶ which also holds significance for the quality of patient care.⁷ Evidence-based strategies, such as the nurse coaching process, offer health systems and nursing administration scalable approaches to assist nurses throughout the bereavement process. The purpose of this article is to promote the nurse coaching process as a tool for nurse leaders to best support staff in a safe and therapeutic environment.

Nurse Coaching and the End-of-Life Nursing Education Consortium

Nurse coaching is a “skilled, purposeful, results-oriented, and structured relationship and person-centered interaction…that is provided by a nurse for the purpose of promoting achievement of a person's goals.”⁸ This process has been used in a number of clinical settings to improve clients' health outcomes.^9-13 The nurse coach prioritizes the well-being of the client (eg, staff nurse) through a relationship-based ethic that integrates the values of holism, caring, and moral insight.^8,14 Coaching conversations include many communication skills that nurses are familiar with—therapeutic presence, deep listening, use of silence, motivational interviewing—to help clients identify their individual barriers and facilitators to realizing their goals.¹⁵

During the COVID-19 pandemic, national palliative nurse experts collaborated with the End-of-Life Nursing Education Consortium to provide resources to support nurses and promote nurse well-being.¹⁶ The infographic in the Figure 1 describes the 6-step nurse coaching process paired with empathic communication tips to help nurse leaders guide staff through bereavement debriefings. An extended webinar presentation on this topic can be accessed free of charge through the End-of-Life Nursing Education Consortium (https://www.aacnnursing.org/ELNEC/COVID-19) to further assist leadership in supporting staff through grief.

FIGURE 1.

End-of-life nursing education consortium (ELNEC) and palliative care informed nurse coaching process to support bereaved staff.

CONCLUSION

Promoting nurse well-being requires systemic supports at organizational and leadership levels to proactively identify and manage the mental health impacts among nurses.¹⁷ Negative work culture, poor supervisor support, and lack of opportunities to share experiences and feelings with other colleagues have been associated with worse mental health outcomes (eg, psychological distress, depression) among health care professionals.^17,18 Thus, institutional resources, such as clinician access to both informal and professional support, undergird health care professionals' abilities to cope with mental health impacts during crises like COVID-19.¹⁹

Strategies to promote team cohesion and opportunities to informally debrief and receive peer support have been advocated, and may offer greater benefit than individualized approaches, which may be insufficient in meeting bereavement needs among health care professionals.^17,19,20 The nurse coaching process can be used in conjunction with other strategies to support bereaved staff during COVID-19 and into the future as the profession begins to collectively evaluate the long-term mental health impacts of the pandemic.